新生儿化脓性脑膜炎病原学特征的多中心研究  

Multicenter study on the etiology characteristics of neonatal purulent meningitis

作　　者：柳艳丽[1] 蔡娇娇 张晓毅 朱敏丽[1] 林振浪[1] 潘益匆 郑俊虎 赵益伟 王翔 卢洪萍[4] 林梅芳 王吉 顾海红 王丽珍 程可萍 戴玉璇[9] 高原 李军胜 方红霞[12] 孙娜[12] 李丽华[13] 李小权 刘英 李瑛瑜[16] 高娃 李敏遐 Liu Yanli;Cai Jiaojiao;Zhang Xiaoyi;Zhu Minli;Lin Zhenlang;Pan Yicong;Zheng Junhu;Zhao Yiwei;Wang Xiang;Lu Hongping;Lin Meifang;Wang Ji;Gu Haihong;Wang Lizhen;Cheng Keping;Dai Yuxuan;Gao Yuan;Li Junsheng;Fang Hongxia;Sun Na;Li Lihua;Li Xiaoquan;Liu Ying;Li Yingyu;Gao Wa;Li Minxia(Department of Neonatology,Yuying Children′s Hospital,Wenzhou Medical University,Wenzhou 325027,China;Department of Neonatology,Yueqing People′s Hospital,Wenzhou 325600,China;Department of Neonatology,Rui′an Maternal and Child Health Hospital,Wenzhou 325200,China;Department of Neonatology,Taizhou Hospital of Zhejiang Province,Taizhou 317099,China;Department of Neonatology,Huzhou Maternal and Child Health Hospital,Huzhou 313002,China;Department of Neonatology,Zhoushan Maternal and Child Health Hospital,Zhoushan 316004,China;Department of Neonatology,Taizhou Enze Hospital,Taizhou 318053,China;Department of Neonatology,Yongkang Maternal and Child Health Hospital,Jinhua 321399,China;Department of Neonatology,Jinhua Central Hospital,Jinhua 321099,China;Department of Neonatology,Jinhua Maternal and Child Health Hospital,Jinhua 321099,China;Department of Neonatology,Lishui Maternal and Child Health Hospital,Lishui 323020,China;Department of Neonatology,Cixi People′s Hospital,Ningbo 315399,China;Department of Neonatology,Beijing Luhe Hospital,Capital Medical University,Beijing 101199,China;Department of Neonatology,The First Affiliated Hospital,Xi′an Jiaotong University,Xi′an 710061,China;Department of Neonatology,Bethune First Hospital,Jilin University,Changchun 130061,China;Department of Neonatology,Tangshan Maternal and Child Health Hospital,Tangshan 063003,China;Department of Neonatology,Inner Mongolia Autonomous Region Maternal and Child Health Hospital,Hohhot 750306,China;Department of Neonatology,Qingyuan People′s Hospital,Qingyuan 511518,China)

机构地区：[1]温州医科大学附属育英儿童医院新生儿科,温州325027 [2]乐清市人民医院新生儿科,温州325600 [3]瑞安市妇幼保健院新生儿科,温州325200 [4]浙江省台州医院新生儿科,台州317099 [5]湖州市妇幼保健院新生儿科,湖州313002 [6]舟山市妇幼保健院新生儿科,舟山316004 [7]台州恩泽医院新生儿科,台州318053 [8]永康市妇幼保健院新生儿科,金华321399 [9]金华市中心医院新生儿科,金华321099 [10]金华市妇幼保健院新生儿科,金华321099 [11]丽水市妇幼保健院新生儿科,丽水323020 [12]慈溪市人民医院新生儿科,宁波315399 [13]首都医科大学附属北京路河医院新生儿科,北京101199 [14]西安交通大学第一附属医院新生儿科,西安710061 [15]吉林大学白求恩第一医院新生儿科,长春130061 [16]唐山市妇幼保健院新生儿科,唐山063003 [17]内蒙古自治区妇幼保健院新生儿科,呼和浩特750306 [18]清远市人民医院新生儿科,清远511518

出　　处：《中华传染病杂志》2023年第6期393-400,共8页Chinese Journal of Infectious Diseases

基　　金：温州市科技局科研项目(Y2020470)。

摘　　要：目的了解中国不同地区新生儿化脓性脑膜炎的主要致病菌分布及药物敏感试验结果。方法采用描述性临床流行病学研究方法,回顾性收集2015年1月至2019年12月中国不同地区18家三级医院收治的新生儿化脓性脑膜炎患儿的血液和脑脊液检查结果、药物敏感试验结果,分析早产儿和足月儿、早发型和晚发型、浙江省和浙江省外其他地区、温州地区和浙江省其他地区新生儿化脓性脑膜炎患儿的病原菌分布。统计学分析采用χ^(2)检验。结果共纳入210例新生儿化脓性脑膜炎病例。常见病原菌为大肠埃希菌[41.4%(87/210)]、无乳链球菌[27.1%(57/210)]。革兰阴性菌在早产儿中的构成比[77.6%(45/58)]高于足月儿[47.4%(72/152)],差异有统计学意义(χ^(2)=15.54,P=0.001)。大肠埃希菌[36.5%(31/85)比44.8%(56/125)]和无乳链球菌[24.7%(21/85)比28.8%(36/125)]在早发型和晚发型病例中的差异均无统计学意义(均P>0.05)。各地区新生儿化脓性脑膜炎最常见的病原菌均为大肠埃希菌,其中浙江省为46.7%(64/137),浙江省外其他地区为31.5%(23/73)。浙江省无乳链球菌感染比例[35.8%(49/137)]高于浙江省外其他地区[11.0%(8/73)],肺炎克雷伯菌、凝固酶阴性葡萄球菌在浙江省外其他地区的构成比[17.8%(13/73)和16.4%(12/73)]均高于浙江省[2.9%(4/137)和5.1%(7/137)],差异均有统计学意义(χ^(2)=14.82、12.26、7.43,均P<0.05)。革兰阳性球菌在温州地区的构成比[60.8%(31/51)]高于浙江省其他地区[38.4%(33/86)],差异有统计学意义(χ^(2)=6.46,P=0.011)。大肠埃希菌对美罗培南敏感(0/45),对氨苄西林的耐药率为74.4%(32/43),对其他常见的头孢菌素存在不同程度的耐药,其中头孢噻肟的耐药率最高[41.8%(23/55)],其次为头孢曲松,耐药率为32.4%(23/71)。无乳链球菌对青霉素、万古霉素、利奈唑胺均敏感。结论中国不同地区新生儿化脓性脑膜炎的主要致病菌分布不同,但最常见的�Objective To study the distribution and antibiotics resistance of the main pathogens of neonatal purulent meningitis in different regions of China.Methods A retrospective descriptive clinical epidemiological study was conducted in children with neonatal purulent meningitis which admitted to 18 tertiary hospitals in different regions of China between January 2015 to December 2019.The test results of blood and cerebrospinal fluid,and drug sensitivity test results of the main pathogens were collected.The distributions of pathogenic bacteria in children with neonatal purulent meningitis in preterm and term infants,early and late onset infants,in Zhejiang Province and other regions outside Zhejiang Province,and in Wenzhou region and other regions of Zhejiang Province were analyzed.The chi-square test was used for statistical analysis.Results A total of 210 neonatal purulent meningitis cases were collected.The common pathogens were Escherichia coli(E.coli)(41.4%(87/210))and Streptococcus agalactiae(S.agalactiae)(27.1%(57/210)).The proportion of Gram-negative bacteria in preterm infants(77.6%(45/58))with neonatal purulent meningitis was higher than that in term infants(47.4%(72/152)),and the difference was statistically significant(χ^(2)=15.54,P=0.001).There were no significant differences in the constituent ratios of E.coli(36.5%(31/85)vs 44.8%(56/125))and S.agalactiae(24.7%(21/85)vs 28.8%(36/125))between early onset and late onset cases(both P>0.05).The most common pathogen was E.coli in different regions,with 46.7%(64/137)in Zhejiang Province and 31.5%(23/73)in other regions outside Zhejiang Province.In Zhejiang Province,S.agalactiae was detected in 49 out of 137 cases(35.8%),which was significantly higher than other regions outside Zhejiang Province(11.0%(8/73)).The proportions of Klebsiella pneumoniae,and coagulase-negative Staphylococcus in other regions outside Zhejiang Province(17.8%(13/73)and 16.4%(12/73))were both higher than those in Zhejiang Province(2.9%(4/137)and 5.1%(7/137)).The differences were all stat

关 键 词：脑膜炎 抗药性 婴儿 新生 化脓性脑膜炎 病原菌 

分 类 号：R51[医药卫生—内科学]